You'll find all claims for each patient by navigating to the patient's billing tab and selecting the Claims section. This overview displays all claim statuses at a high level, providing a quick snapshot of the current situation. To focus on specific claim statuses, use the filter icon next to the Status column. This feature helps prioritize your workflow by allowing you to concentrate on claims needing immediate attention.
Osmind Analytics is able to filter by the new claim statuses.
Claim Status Glossary
Payers provide a wide array of statuses and details for claims, which can be overwhelming. We've streamlined this process by condensing these statuses into a simplified set. This approach aims to provide you with clear, actionable information about the state of each claim.
Osmind Status | What it means |
Draft | Claim is in draft, not yet submitted. |
Submitted | Claim has been successfully submitted from Osmind to Change Healthcare |
Manually Submitted | Claim was submitted elsewhere, not through the integrated pathway Osmind has with Change. |
Received | The claim has been received by the payer, but not necessarily accepted into their adjudication system. |
Accepted | The claim has been accepted into the payer's adjudication system. |
In processing | Claim is in the payer's adjudication system |
Processed/Paid | The claim has completed adjudication & has been paid. |
ERA Received | An ERA has been returned for the claim. |
Adjudicated | The claim is fully adjudicated. |
Forwarded | The claim has been forwarded by the payer to another entity. |
Finalized - Forwarded | The claim was processed and paid by the payer. The payer forwarded the claim to another entity (likely another payer). |
Settled | The claim's outstanding balance (meaning the full claim amount) has been fully settled in Osmind. |
Revised | The payer sent updated adjudication information for a claim. |
Below are more statuses that may require action.
Osmind Status | What it means |
Submission Error or Change Error | The claim was attempted to be submitted from Osmind, but was not successful. Typically, an error message will show up at the top of the claim after the submit fails. You have to correct what is wrong & attempt resubmission. |
Pending | Generic message about a pended claim. Means typically that no remittance advice has been issued, or only part of the claim was paid. You could reach out to the payer to understand what's happening |
Accepted with warning | The claim has been accepted by the payer, but has a warning. View the status details within the claim to understand what the warning is about. |
Info request | Information is needed in order for the payer to continue processing the claim - either from the clinic, or from the patient. The status code details inside the claim will let you know what information is needed and who from. |
Rejected | The claim has been returned by the payer as un-processable. |
Denied | The payer denied the claim, meaning they will not pay out. |
Suspended in review | Claim is pending review (e.g., medical review, repricing, Third Party Administrator Processing). |
On hold | The payer put the claim on hold. |
Claim not found | The claim is not present in the payer's system. |
Error | The claim status is not working - either due to a clearinghouse system issue, payer system issue, or other. |
Finalized - Paid and not forwarded | The claim was processed and paid by the payer. The payer did not forward the claim to another entity (likely another payer). |
Viewing Claim Status Details
To see the details of a status, click into an individual claim. Once a status report has been sent by a payer, the status details section will be available on the claim in Osmind, as shown below (two visual examples). In the Status details section you will find:
Last update received: This shows you the date the status report was received from the payer
Category Code: This is the full, high-level status description provided by the payer.
Status Code: This is the detail sent back by the payer - typically tells you what the issue is.
Entity Code: This field tells you who the information is about. It may not always be sent back in status reports we receive, so it may be empty.
